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BlueCross BlueShield of Tennessee este un furnizor de planuri de sănătate cu sediul în Tennessee, care deservește 3,4 milioane de membri prin activitatea sa în domeniul serviciilor medicale și al asigurărilor. În calitate de licențiat independent al Blue Cross Blue Shield Association și emitent eligibil pentru planurile de pe Piața asigurărilor de sănătate, compania combină acoperirea medicală cu serviciile pentru clienți și îngrijirea axată pe comunitate. Oportunitățile de carieră acoperă o gamă largă de domenii profesionale, inclusiv programul de internship BlueBridge, care îi ajută pe studenți și pe proaspeții absolvenți să își înceapă cariera. BlueCross BlueShield of Tennessee pune, de asemenea, accent pe un mediu de lucru în care angajații sunt apreciați, respectați și incluși.
Senior Clinical Business Analyst - Tennessee Remote
Senior Clinical Business Analyst supporting BlueCross BlueShield of Tennessee’s medical policy operations. The role combines healthcare analytics, process improvement, interoperability, and responsible AI adoption.
Descriere
- Advance medical policy operations with the Medical Policy Research & Development team through evidence-based practices, process improvement, and AI-enabled solutions.
- Develop and maintain medical policies through literature surveillance, regulatory and clinical guideline monitoring, and support for interoperability and healthcare digitization initiatives.
- Evaluate clinical, operational, and financial data to identify improvements in quality, utilization, access, and service delivery.
- Lead workflow and process analysis and recommend and implement evidence-based improvements.
- Convert clinical and business needs into requirements and actionable insights with clinical, operations, IT, and analytics partners.
- Provide subject-matter guidance and education on clinical workflows, data interpretation, reporting, and system functionality.
- Maintain compliance with regulatory, accreditation, and internal governance standards.
- Support the evaluation, implementation, and optimization of clinical and business processes, applications, and technology-enabled solutions.
- Evaluate, plan, and support responsible AI adoption, including use-case assessment, requirements definition, and performance monitoring.
- Analyze adoption, performance, and outcome data for technology solutions.
- Help develop policies, controls, and governance frameworks for technology use in clinical and operational settings.
Cerințe
- Bachelor’s degree or equivalent professional experience is required.
- Equivalent experience means four years of professional work in healthcare, clinical operations, or a corporate environment.
- Active Tennessee or compact-state RN license, or an active Tennessee master’s-level social work license such as LMSW or LCSW.
- Three years of experience in clinical operations, care management, utilization management, population health, or a comparable healthcare setting.
- Two years of experience in reporting, data analysis, business analysis, or performance improvement.
- One year of experience supporting projects, initiatives, or cross-functional workgroups.
- Experience partnering with clinical, operational, and technical teams to improve workflows, systems, or performance outcomes.
- Experience evaluating and supporting AI-enabled or advanced analytics solutions.
- Strong analytical, critical-thinking, and problem-solving skills.
- Ability to turn clinical and operational needs into clear business requirements.
- Sound judgment regarding risk, bias, appropriateness, and governance for analytics and AI-driven clinical tools.
- Proficiency with Microsoft Office, including Outlook, Word, Excel, Access, and PowerPoint.
- Experience with database reporting and data analysis.
- Ability to work independently and collaboratively within a team.
- Demonstrated ability to manage multiple projects, priorities, and timelines.
- Excellent written and verbal communication skills.
- Strong interpersonal, organizational, and time-management abilities.
- Comfort working in a fast-moving environment with emerging technologies and shifting priorities.
- Demonstrated proficiency and comfort using AI-enabled technologies and tools.
Beneficii
- Remote work arrangement.
- Employee position.
- Equal employment opportunity and nondiscrimination protections.
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